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Prolonged rewarming time during allograft implantation predisposes to recurrent hepatitis C infection after liver transplantation
Author(s) -
Baron Pedro W.,
Sindram David,
Higdon Dave,
Howell David N.,
Gottfried Marcia R.,
TuttleNewhall Janet E.,
Clavien PierreAlain
Publication year - 2000
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1053/jlts.2000.7581
Subject(s) - medicine , liver transplantation , cirrhosis , hepatitis c , liver disease , hepatitis c virus , gastroenterology , disease , viremia , transplantation , hepatitis , prothrombin time , immunology , virus
The majority of patients undergoing orthotopic liver transplantation (OLT) have end‐stage liver disease secondary to hepatitis C virus (HCV) infection. Although OLT does not cure the disease and recurrent virus is present in all patients, relatively few patients with recurrent viremia develop clinical disease. When the disease recurs, however, the results can be devastating. Factors associated with increased risk for recurrent HCV disease remain controversial. We hypothesized that preservation injury may predispose to the severity of HCV disease after OLT. We reviewed our series of OLTs performed for HCV cirrhosis between January 1994 and December 1998 (n = 56; 62 transplants). Patients were grouped according to the severity of recurrent hepatitis C. Group 1 had no or mild HCV disease (n = 36), and group 2 had moderate to severe HCV disease (n = 20). The duration of ischemic rewarming during graft implantation was significantly associated with the severity of recurrent hepatitis C ( P < .04). The estimated chances of severe disease within the first year post‐OLT after 30, 60, or 90 minutes of ischemic rewarming time were 19%, 40%, and 65%, respectively. Cold ischemia time, transaminase levels, and prothrombin time did not correlate with the severity of hepatitis C. In conclusion, our data suggest that the duration of ischemic rewarming predisposes to severe recurrent hepatitis C. This finding warrants the investigation of the pathogenesis of recurrent HCV disease after ischemic injury. Reduction of rewarming time should be stressed in OLT, particularly in patients with HCV cirrhosis.